Table 2 Focus group themes: Factors affecting recruitment and retention
Theme | “Push” factor (leave job) | “Pull” factor (recruit/retain in job) |
|---|---|---|
Personal factors: | Lack of job opportunities for spouses | |
Perceived inadequate quality of secondary schools | Attraction to rural lifestyle | |
Care for elderly parents | Good place to raise children | |
Retirement | Married to a local resident | |
Family members living in a metropolitan area | Rural origin/family in area | |
For younger AHP’s: | Low cost of living | |
Limited social opportunities | Personal engagement in the community | |
Desire for adventure/travel | ||
Career progression: | Better career opportunities in metropolitan settings | NSW Health Award structure (accelerated promotion for new graduates in rural practice settings) |
Lower income, smaller market for rural private practitioners | Recognition by peers and others | |
Rural senior positions unavailable or not open for recruitment | Advanced work roles | |
Appropriate remuneration | ||
Workload and type of work: | Unmanageable workload | Altruism, making a difference |
Crisis mode of service, reactive not preventive | Direct individual patient care | |
Paperwork, reporting requirements | Generalist practice with advanced work roles - ‘specialist generalist’ | |
Challenge, variety and intellectual stimulation embedded in the job | ||
Continuing Professional Development (CPD): | Limited access to CPD due to: | University campus in regional centres increases CPD access |
Lack of management support to attend CPD events | Access to CPD: | |
Cost of travel | ameliorates professional isolation | |
Expensive registrations (metropolitan courses) | is strongly linked with job satisfaction | |
Time away from work | is essential for new graduates and isolated practitioners | |
High workload demands | Assures that senior clinicians skills remain up to date | |
Provides intellectual challenge and opportunities for career progression | ||
The impact of management: | Perceived inequitable or inappropriate resource allocation | Supportive line managers |
Nurse managers | Support for CPD access | |
Failure to recruit vacant positions | Clinical mentorship for new graduates | |
Constant change | Flexible work hours | |
Managers who are unresponsiveness to suggestions | Autonomy | |
Feeling de-valued | Equitable resource allocation sufficient to deliver clinical services | |
Ethical compromise – fiscal vs. clinical imperatives | Realistic estimate of workload capacity | |
Move to private practice to escape public sector “management |